The Los Angeles 2028 Paralympic Games are expected to deliver the highest level of sporting performance in Paralympic history, as athletes benefit from increasingly sophisticated coaching, sports science, rehabilitation and assistive technology.
The International Paralympic Committee says competitive standards are continuing to rise rapidly across Para sport, with athletes now training within increasingly professional performance environments.
For the prosthetics and orthotics profession, that evolution is particularly important.
As margins between medal positions become smaller, prosthetists and orthotists supporting elite Para athletes are increasingly moving beyond conventional rehabilitation and becoming part of multidisciplinary high-performance teams.
That creates an important opportunity across the IMEA region, where a large population of people with disabilities sits alongside rapidly growing investment in sport, rehabilitation and assistive technology.
Paris 2024 demonstrated how competitive Para sport has become
The scale of performance development was already apparent at the Paris 2024 Paralympic Games.
According to the International Paralympic Committee, athletes produced 175 world records and 218 Paralympic records during the Games.
The IPC has also highlighted how rapidly standards have advanced between successive Paralympic cycles. Performances capable of winning major medals at earlier Games may now be insufficient even to qualify for finals in some events.
Margins between competitors are becoming exceptionally small.
In Para athletics at Paris 2024, 32 medal events were reportedly decided by less than 0.1 seconds or 10 centimetres.
When results are decided at that level, every part of an athlete’s preparation can become significant.
That includes training and conditioning, but for athletes using prosthetic or orthotic devices it can also include socket design, alignment, suspension, component selection, interface materials and biomechanical optimisation.
LA28 will be the largest Paralympic Games to date
The Los Angeles Paralympics are scheduled to begin on 15 August 2028 and are expected to feature approximately 4,480 athletes representing around 165 National Paralympic Committees.
Athletes will compete across 23 sports, with Para climbing joining the Paralympic programme for the first time.
The growing scale of the Games reflects a wider transformation in Para sport.
More athletes are now able to train full time, while national programmes increasingly provide access to sport scientists, physiotherapists, strength and conditioning coaches, psychologists, nutrition specialists and advanced performance laboratories.
CPOs can become another part of that environment.
From fitting a prosthesis to optimising performance
The requirements of an elite Para athlete can differ considerably from those of a conventional rehabilitation patient.
A person receiving their first lower-limb prosthesis may initially be focused on standing, walking safely, negotiating stairs and returning to daily activities.
An elite athlete may instead be asking whether an adjustment can improve stability through a corner, reduce movement within the socket during sprinting or help maintain comfort during repeated high-intensity training sessions.
Those differences place substantial demands on the prosthetist.
Socket fit may need to be managed around changing muscle volume and training loads. Components may undergo much greater forces than during everyday walking, while athletes may need separate devices for sport, training and daily use.
Frequent adjustments can also be necessary as the athlete develops physically and technically.
In that environment, the CPO becomes part clinician, part technical specialist and part performance problem-solver.
Orthotists also have an important role
Sports P&O is not limited to amputee athletes.
Para athletes with neurological conditions, muscle weakness, joint instability and other impairments may require specialist orthotic interventions designed specifically for their sporting activity.
These devices can require a different approach from an orthosis intended primarily for everyday mobility.
Weight, stiffness, energy return, range of movement and compatibility with sports equipment may all need to be considered.
Custom foot orthoses can also play a role in managing loading and biomechanics for athletes with both disabilities and secondary musculoskeletal problems.
The opportunity therefore extends across the full P&O profession.
Technology is changing elite sports rehabilitation
LA28 will arrive during a period of rapid technological development across prosthetics and orthotics.
CPOs now have access to tools including:
- 3D residual-limb scanning
- Digital socket design
- Advanced composite materials
- Additive manufacturing
- Plantar pressure analysis
- Motion capture
- Wearable sensors
- Force measurement
- Digital gait analysis
- Data-driven rehabilitation platforms
The most important change may not be any single technology, but the ability to combine information from multiple sources.
A prosthetist supporting a runner, for example, may be able to combine video analysis, pressure data, athlete feedback and alignment changes to evaluate an intervention more objectively.
Similarly, orthotists may use pressure and movement analysis to examine how a device is interacting with the athlete during real sporting movements rather than relying solely on observations made during normal walking.
Major opportunity across the IMEA region
The growth of Para sport creates a particularly interesting opportunity across the Indian subcontinent, Middle East and Africa.
The region includes countries with very different levels of rehabilitation infrastructure, but investment in sport is increasing rapidly in several markets.
Saudi Arabia, the UAE, Qatar and other Gulf countries have invested significantly in sports medicine, high-performance facilities and international sporting events.
India has experienced a major rise in Paralympic performance and visibility.
Across Africa, Para athletes continue to demonstrate significant sporting potential despite often having access to fewer technical and financial resources than competitors from established high-performance systems.
There is therefore considerable scope for P&O professionals across IMEA to develop dedicated expertise in sports prosthetics, sports orthotics and high-performance rehabilitation.
More than access to expensive components
Elite sports prosthetics are sometimes portrayed primarily as a technology story.
High-performance prosthetic feet and running blades are highly visible, but the component itself is only one part of the system.
The athlete still needs appropriate clinical assessment, socket design, suspension, alignment and ongoing technical support.
An expensive component fitted poorly will not deliver elite performance.
This is an important point for developing Para sport programmes across IMEA.
Building high-performance capacity cannot simply involve purchasing advanced prosthetic technologies. It also requires investment in the CPOs capable of prescribing, fitting, adjusting and maintaining them.
That means specialist training and exposure to sports biomechanics could become increasingly valuable areas of professional development.
CPOs as members of the performance team
The evolution towards LA28 demonstrates how the role of the prosthetist and orthotist can extend far beyond traditional rehabilitation.
At elite level, the CPO may work alongside:
- Coaches
- Sports physicians
- Physiotherapists
- Biomechanists
- Strength and conditioning specialists
- Engineers
- Sports scientists
- Classification teams
That multidisciplinary model could eventually influence wider rehabilitation practice as well.
Technologies and clinical methods developed around elite athletes often generate knowledge that can later be applied to active recreational users and other patients seeking higher levels of mobility.
LA28 could redefine expectations again
The International Paralympic Committee expects Los Angeles 2028 to raise the performance benchmark once more.
For athletes, that means greater competition.
For the P&O community, it means a growing requirement for clinicians capable of supporting people whose ambitions extend far beyond basic mobility.
A future prosthetic patient may not simply want to return to walking.
They may want to run competitively, play football, climb, cycle, lift weights or represent their country.
As Paralympic performance continues to advance, the ability of CPOs to support those ambitions could become an increasingly important specialist area of the profession.
And with medal outcomes now sometimes decided by fractions of a second or centimetres, the quality of prosthetic and orthotic intervention may become one of many small but potentially decisive pieces of the high-performance puzzle.
- International Paralympic Committee – LA28 performance outlook
- LA28 Paralympic Games
- International Paralympic Committee
- International Society for Prosthetics and Orthotics
- IMEA CPO